Lawmakers debate medicating mental patients against their will

Jan. 22, 2014

Dr. Gordon Frankle, chief of psychiatry at Rutland Regional Medical Center, and Dr. Craig Van Tuinen, psychiatrist in private practice, disagreed about the need to speed up the process for deciding whether psychiatric patients should receive medication against their will. Dr. Frankle testified that the long process can leave some patients in a 'tortured state' for weeks. Van Tuinen countered that he didn't believe the current judicial review process needed to be changed. / NANCY REMSEN/FREE PRESS

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Free Press Staff Writer

MONTPELIER — The chief of psychiatry at Rutland Regional Medical Center urged lawmakers Wednesday to change the law that governs decisions about when mentally ill patients may be given medications against their will because the current process takes too long.

State law requires officials to go to court when psychiatric patients refuse to take medications that doctors believe will treat the patients’ acute illnesses. The process, which first requires a court decision on involuntary hospitalization and then a separate proceeding on the medication question, takes weeks.

The wait, Dr. W. Gordon Frankle told senators from the Judiciary and Health and Welfare committees, “is an extremely stressful experience. To see people waiting four, five or six weeks, struggling in this really tortured state, is really hard.”

Dr. Craig Van Tuinen, a psychiatrist often called on to render independent evaluations about the need for involuntary medication, countered that time helps patients learn to trust caregivers and make treatment decisions on their own.

“In a lot of ways, I don’t think the current process is broken,” Van Tuinen told the two Senate panels. “There is more to the treatment process than getting them in the hospital and giving them medication as soon as possible.”

Van Tuinen acknowledged that some individuals do require rapid turnaround when they refuse medication and pose a danger to themselves or others, but he argued, “The current system allows for that.”

“We have to have a system that flows,” Mental Health Commissioner Paul Dupre testified. “The statistics, when I look at them, show people are in hospital situations much longer than our system is set up for.”

After the state psychiatric hospital in Waterbury closed in the fall of 2011, Dupre said policymakers created a new model for treatment of mental illness. “The Vermont State Hospital had a culture of people being there for a long time, a whole different framework than we are moving to right now.”

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Human Services Secretary Douglas Racine told senators that the Shumlin administration supported change in the involuntary medication process. “The administration feels what this bill is trying to do is help people get well faster.”

Gov. Peter Shumlin included support for a faster process in his budget speech last week.

“We are an outlier among the states because it takes so long for treatment decisions to wind their way through our court system,” Shumlin told the joint assembly.

Racine, a former state senator, acknowledged the challenge of reaching consensus on this contentious issue, but he urged lawmakers to give it a try.

“I believe we can craft legislation that expedites the process and protects the rights of the patients,” Racine said. “This really is an attempt to find a better balance.”

Jack McCullough, director of the Mental Health Law Project for Vermont Legal Aid, countered that the state had already achieved the appropriate balance.

“I’m concerned with expediting justice all the way out of the system,” he told senators. “We are talking about a constitutional right to liberty.”

“These cases are complicated,” he said. His staff and the psychiatrists conducting independent evaluations “often go through four-, five-, six-hundred pages of medical records. These are not things you can do overnight.”

McCullough also argued that the length of the process had value because it often allowed patients “to come to the point where they agree to cooperate.”

Administrative Judge Amy Davenport confirmed that 70 percent of the applications for involuntary hospitalization end up being dismissed prior to court hearings.

However, Davenport noted that among the 42 applications for involuntary medication, 32 went to hearing.

“Is there a problem from your perspective with the current system?” Sen. Richard Sears, D-Bennington, asked Davenport.

“I think we could do a better job of having an expedited track,” Davenport said. She wasn’t, however, advocating a faster process for all cases, she said.

Senators will continue taking testimony on Ayer’s involuntary medication bill next week. Sears, who chairs the Senate Judiciary Committee, said the panel would focus on the proposed changes in the process next Tuesday morning.

The two committees will host a hearing for patients and families from 5-7 p.m. Jan. 30 at the Statehouse.

As the three-hour hearing concluded, Sears noted that the number of patients who ended up forced to take medications was small — 28 in the most recent fiscal year, according to Administrative Judge Davenport.

“How do we get to the 28 quicker?” he posed to the audience. “If we all work together on how to get to the 28, the system would work much better.”